Bipolar versus monopolar resection of benign prostate hyperplasia: a comparison of plasma electrolytes, hemoglobin and TUR syndrome

Meltem Savran Karadeniz, Erdem Bayazit, Omur Aksoy, Emine Aysu Salviz, Tzevat Tefik, Oner Sanli, Mukadder Orhan Sungur, Kamil Mehmet Tugrul, Meltem Savran Karadeniz, Erdem Bayazit, Omur Aksoy, Emine Aysu Salviz, Tzevat Tefik, Oner Sanli, Mukadder Orhan Sungur, Kamil Mehmet Tugrul

Abstract

Background: Bipolar and monopolar transurethral resection of prostate (TURP) are both widely used for surgical treatment of benign prostatic hyperplasia. Systemic absorption of irrigation fluids during TURP operations leads to variations in blood chemistry. The aim of this prospective clinical study was to compare two different surgical techniques and the systemic effects of irrigation solutions (5 % mannitol vs. 0.9 % sodium chloride) under standardized anesthesia care.

Methods: Fifty-two patients who were scheduled for elective TURP were enrolled in the study. Patients were divided into two groups; the group M; 5 % mannitol was used for irrigation and the group B; 0.9 % sodium chloride was used for irrigation. Spinal anesthesia was performed to all patients. The patients' demographics, prostate volumes, hemodynamic parameters, volumes of irrigation, and IV fluids were recorded. Serum electrolytes (Na+, K+) and hemoglobin (Hb) were analyzed in blood samples taken before the operation (control), at the 45th min of the operation (1st measurement), and 1 h after the end of the surgery (2nd measurement) and recorded.

Results: The Na+ value of group M was significantly lower in both the 1st and 2nd measurements compared with the control value (p < 0.001 and p < 0.001). Na+ values of group M were also significantly lower than group B in both the 1st and 2nd measurements (p < 0.001 and p < 0.001). The change in Na+ levels was found to be statistically significant (p < 0.001) in group M, whereas the intergroup changes were not statistically significant in group B.

Conclusion: Our results demonstrated that bipolar resection coupled with 0.9 % sodium chloride has minimal effects on serum sodium levels compared with monopolar resection. Clinicaltrials.gov identifier NCT02681471.

Keywords: 0.9 % Sodium chloride; 5 % Mannitol; Bipolar; Monopolar; Serum electrolytes; Transurethral resection of prostate.

Figures

Fig. 1
Fig. 1
Consolidated Standards of Reporting Trials (CONSORT) diagram of Groups M and B. Group M includes patients undergoing TURP (5 % mannitol was used for irrigation); Group B includes patients undergoing TURP (0.9 % sodium chloride was used for irrigation)
Fig. 2
Fig. 2
Heart rate (HR) follow-up in Groups 1 and 2 though the perioperative period
Fig. 3
Fig. 3
Systolic (SBP) and diastolic blood pressure (DBP) follow-up in Groups 1 and 2 though the perioperative period

References

    1. Akçayöz M, Kaygısız O, Akdemir O, Aki FT, Adsan O, Cetinkaya M. Comparison of transurethral resection and plasmakinetic transurethral resection applications with regard to fluid absorption amounts in benign prostate hyperplasia. Urol Int. 2006;77:143–147. doi: 10.1159/000093909.
    1. Collins JW, MacDermott S, Bradbrook AR, Keeley FX, Timoney AG. A comparison of the effect of 1.5 % glycine and 5 % glucose irrigants on plasma serum physiology and the incidence of transurethral resection syndrome during prostate resection. BJU Int. 2005;96:368–372. doi: 10.1111/j.1464-410X.2005.05633.x.
    1. Collins CW, MacDermott S, Bradbrook AR, Keeley XF. A comparison of the effect 1,5 % glisin and 5 % glucose irrigants on plasma serum physiology and the incidence of transurethral resection syndrome during prostate resection. BJU Int. 2005;96:368–372. doi: 10.1111/j.1464-410X.2005.05633.x.
    1. Dar FA, Mushtag MB, Mushtag U. Hiperbaric spinal ropivacain in lower limb and hip surgery: a comparision with hyperbaric bupivacaine. J Anaesthesiol Clin Pharmacol. 2015;31(4):466–470. doi: 10.4103/0970-9185.169064.
    1. De la Rosette JJ, Alivizatos G, Madersbacher S, Perachino M, Thomas D, Desgrandchamps F, de Wildt M. EAU guidelines on benign prostatic hyperplasia (BPH) Eur Urol. 2001;40(3):256–263. doi: 10.1159/000049784.
    1. Engeler DS, Schwab C, Neyer M, Grün T, Reissigl A, Schmid HP. Bipolar versus monopolar TURP: a prospective controlled study at two urology centers. Prostate Cancer Prostatic Dis. 2010;13(3):285–291. doi: 10.1038/pcan.2010.1.
    1. Hahn RG. Fluid absorption in endoscopic surgery. Br J Anaesth. 2006;96(1):8–20. doi: 10.1093/bja/aei279.
    1. Hawary A, Mukhtar K, Sinclair A, Pearce I. Transurethral resection of the prostate syndrome: almost gone but never forgotten. J Endourol. 2009;23:2013–2020. doi: 10.1089/end.2009.0129.
    1. Ho HS, Yip SK, Lim KB, Fook S, Foo KT, Cheng CW. A prospective randomized study comparing monopolar and bipolar transurethral resection of prostate using transurethral resection in saline (TURIS) system. Eur Urol. 2007;52(2):517–522. doi: 10.1016/j.eururo.2007.03.038.
    1. Issa MM. Technological advances in transurethral resection of the prostate: bipolar versus monopolar TURP. J Endourol. 2008;22:1587–1595. doi: 10.1089/end.2008.0192.
    1. Issa MM, Young MR, Bullock AR, Bouet R, Petros JA. Dilutional hyponatremia of TURP syndrome: a historical event in the 21st century. Urology. 2004;64:298–301. doi: 10.1016/j.urology.2004.03.023.
    1. Michielsen DP, Coomans D, Braeckman JG, Umbrain V. Bipolar transurethral resection in saline: the solution to avoid hyponatraemia and transurethral resection syndrome. Scand J Urol Nephrol. 2010;44(4):228–235. doi: 10.3109/00365591003720275.
    1. Neyer M, Reissigl A, Schwab C, Pointer J, Abt D, Bachmayer C, Schmid HP, Engeler DS. Bipolar versus monopolar resection of prostate: results of a comparative prospective bicenter study-perioperative outcome and long-term efficacy. Urol Int. 2013;90:62–67. doi: 10.1159/000343688.
    1. Norlen H. İsotonic solutions of mannitol, sorbitol and glycine and distilled water as irrigating fluids during transurethral resectıon of the prostate. Scand J Urol Nephrol Suppl. 1985;96:1–50.
    1. Omar M, Lam T, Alexander C, Graham J, Mamoulakis C, Imamura M, Maclennan S, Stewart F, N’dow J. Systemic review and meta-analysis of the clinical effectiveness of bipolar compared with monopolar transurethral resection of the prostate (TURP) BJU Int. 2014;113:24–35. doi: 10.1111/bju.12281.
    1. Rassweiler J, Teber D, Kuntz R, Hoffmann R. Complications of transurethral resection of the prostate (TURP)-incidence, management and prevention. Eur Urol. 2006;50:969–979. doi: 10.1016/j.eururo.2005.12.042.
    1. Reich O, Gratzke C, Stief CG. Techniques and long-term results of surgical procedures for BPH. Eur Urol. 2006;49:970–978. doi: 10.1016/j.eururo.2005.12.072.
    1. Reich O, Gratzke C, Stief CG. Techniques and long term results of surgical procedures for BPH. Eur Urol. 2006;49:970–978. doi: 10.1016/j.eururo.2005.12.072.
    1. Reich O, Gratzke C, Bachman A, Seitz M, Schlenker B, Hermanek P, Lack N, Stief CG. Morbidly, mortality and early outcome of transurethral resection of prostate: a prospective multicenter evaluation of 10,654 patients. J Urol. 2008;180:246–249. doi: 10.1016/j.juro.2008.03.058.
    1. Schulz KF, Altman DG, Moher D, CONSORT Group CONSORT 2010 statement: updated guidelines for reporting parallel group randomized trials. BMC Med. 2010;8:18. doi: 10.1186/1741-7015-8-18.
    1. Singh H, Desai MR, Shrivastav P, Vani K. Bipolar versus monopolar transurethral resection of prostate: randomized controlled study. J Endourol. 2005;19(3):333–338. doi: 10.1089/end.2005.19.333.
    1. Starkman JS, Santucci RA. Comparison of bipolar transurethral resection of prostate with standard transurethral prostatectomy: shorter stay earlier catheter removal and fewer complications. BJU Int. 2005;95:69–71. doi: 10.1111/j.1464-410X.2005.05253.x.
    1. Tang Y, Li J, Pu C, Bai Y, Yuan H, Wei Q, Han P. Bipolar transurethral resection versus monopolar transurethral resection for benign prostatic hypertrophy: a systemic review and meta-analysis. J Endourol. 2014;28(9):1107–1114. doi: 10.1089/end.2014.0188.
    1. Taylor B, Jaffe W. Electrosurgical transurethral resection of the prostate and transurethral incision of the prostate (monopolar techniques) Can J Urol. 2015;10:24–27.
    1. Xie C-Y, Zhu G-B, Wang X-H, Liu X-B. Five-year follow-up results of a randomized controlled trial comparing bipolar plasmakinetic and monopolar transurethral resection of the prostate. Yonsei Med J. 2012;53(4):734–741. doi: 10.3349/ymj.2012.53.4.734.
    1. Yousef AA, Suliman GA, Elashry OM, Elsharaby MD, Ael-N Elgamasy. A randomized comparison between three types of irrigating fluids during transurethral resection in bening prostatic hyperplasia. BMC Anaesthesiol. 2010;10:2–7. doi: 10.1186/1471-2253-10-2.

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